The issue: The Post-2015 Sustainable Development Goals are the successors to the Millennium Development Goals; a draft was published, and the details of the SDGs are being negotiated now. Hygiene is essential for achieving global development, and is therefore included as a target as part of Goal 6. Countries will commit to demonstrating progress on achieving the targets by reporting on indicators. However, in the recent list of global-level indicators being considered by the UN Statistical Commission, hygiene has been deleted. This is likely because the decision makers want a shorter list of indicators. However, demoting hygiene to a huge, secondary list of ‘optional’ indicators will not give hygiene the priority needed for the SDGs to have real impact on both hygiene and the areas that it influences—such as health, education, and equity.

Objective: The JMP Communications and Advocacy Group is coordinating delivery of a persuasive message about the importance of hygiene to encourage decision makers and stakeholders to act and recommend the reinstatement of a hygiene indicator in the list of global-level indicators for the SDGs.

Audience: This letter will be sent to members of the UN Statistical Commission and others who may have the opportunity to influence discussions and decisions around the SDG Indicators process.

A new report shows that the Global Sanitation Fund (GSF) has supported governments and hundreds of their national partners in 13 countries, stretching from Cambodia to Senegal, to enable 7 million people in more than 20,500 communities to end open defecation.

These results are published in the GSF’s latest Progress Report (link to report; link to photos), which highlights cumulative results from the start of the fund until the end of 2014. Nationally-led programmes supported by the GSF have enabled:

4.2 million people with improved toilets

7 million people and more than 20,500 communities to be open-defecation free

8 million people with handwashing facilities

Currently, 2.5 billion people, or 40% of the global population, lack access to decent sanitation. Of those, more than a billion defecate in the open. Diarrheal disease, largely caused by poor sanitation and hygiene, is a leading cause of malnutrition, stunting and child mortality, claiming nearly 600,000 under-5 lives every year. Inadequate facilities also affect education and economic productivity and impact the dignity and personal safety of women and girls.

Established by the Water Supply and Sanitation Collaborative Council (WSSCC), the GSF funds behaviour change activities to help large numbers of poor people in the hardest-to-reach areas attain safe sanitation and adopt good hygiene practices. These activities are community-led, support national efforts, and bring together a diverse group of stakeholders in order to address, at a large scale, the severe deficiencies in access to sanitation and hygiene.

The GSF is a pooled financing mechanism with the potential to further accelerate access to sanitation for hundreds of millions of people over the next 15 years. Between 2013 and 2014 alone, the GSF reported an almost 90 percent increase in the number of people living open-defecation free in target regions of 13 countries[1] across Africa and Asia. During this same period, the GSF has also supported a 55 percent increase in the number of people with access to improved toilets in those same areas. The United Nations system has identified global funds as an important tool to enable member countries to achieve their national development targets, including those for sanitation and hygiene.[2]

“These results prove that we are moving closer to our vision of a world where everybody has sustained sanitation and hygiene, supported by safe water,” said Chris Williams, Executive Director of WSSCC. “This is a crucial step towards achieving better health, reducing poverty and ensuring environmental sustainability for the most marginalized people in the world.”

These GSF results have been achieved due to the work of more than 200 partners, including executing agencies and sub-grantees composed of representatives from governments, international organizations, academic institutions, the United Nations and civil society. One of the strongest success factors in the GSF approach is that it allows flexibility for countries to develop their programmes within the context of their own institutional framework and according to their own specific sanitation and hygiene needs, sector capacity and stakeholders. This implementation methodology is used to reach large numbers of households in a relatively short period of time and is vital for scaling up safe sanitation and hygiene practices.

“GSF is one of the few funds for government-led, donor-funded sanitation and hygiene programmes,” said Williams. “It can uniquely serve as a catalyst to the wider sector as a model that is replicable for others interested in large-scale behaviour change.”

Reaching scale has required that sub-grantees can identify influential, strategic communities, and make effective use of natural leaders, religious and local leaders, or hundreds of others who serve as individual sanitation and hygiene champions. GSF supported programmes apply a local delivery mechanism that engages households in thousands of villages, which enables people to make informed decisions about their sanitation and hygiene behaviour that can improve their health, education and productivity.

The report also highlights the GSF’s impact on national programmes. In Uganda, there are now more than 1.4 million people living in open-defecation free (ODF) environments, thanks to GSF-funded activities, and close to three million people have been reached by hygiene messages as a result of decentralized local government intervention. In Madagascar, over 1.3 million people are now living in ODF environments – in all 22 of the countries regions – and India’s GSF-supported programme has over 782,000 people with handwashing facilities.

“Access to improved sanitation has to be a sustainable reality for every person in the community, regardless of age, gender or disability, in order for the health and other benefits to be enjoyed by all,” said David Shimkus, Programme Director of the GSF. “This report shows that GSF-supported programmes are making major strides in achieving improved sanitation and hygiene for the most vulnerable, and all stakeholders will continue to work together to ensure such progress continues.”

The Governments of Australia, Finland, the Netherlands, Sweden, Switzerland and the United Kingdom have contributed to the GSF since its establishment in 2008. Close to $105 million has been committed for 13 country programmes, which aim to reach 36 million people.

Dakar, Senegal 25th May – Unilever, through health soap brand Lifebuoy is calling on African leaders gathering in Senegal this week for AfricaSan – the continent’s pre-eminent sanitation and hygiene conference – to recognise the role of public private partnerships in addressing newborn and child health. The move comes as Lifebuoy announces the renewal of its partnership with USAID and the expansion of newborn hygiene programmes across Kenya following a successful four-year partnership. Lifebuoy aims to reach 71 million across Africa by 2020 as part of its behaviour change programme which has engaged 257 million people in 24 countries, since 2010.

In its mission to reach 1 billion people with its lifesaving message of handwashing with soap, Lifebuoy joined forces with USAID and its Maternal and Child Survival Programme (MCSP), to create a dedicated newborn programme to make handwashing with soap commonplace among mothers. Worldwide, 40% of under-5 deaths occur in the newborn period and handwashing with soap is one of the most cost-effective ways to reduce preventable diseases like diarrhoea and pneumonia, the main causes of child mortality.

The programme will combine Lifebuoy’s marketing and consumer expertise and proven handwashing behaviour change methodology, with MCSP’s ability to deploy programmes on a large scale, allowing the partnership to reach millions of new mothers. The collaboration proves the vital role that public private partnerships play in public health interventions in Africa and beyond.

“Most newborn deaths due to infection could be averted through simple preventive measures, such as improving hygiene and ensuring curative care is available to sick children. Unilever and USAID renew our commitment to scale up newborn hygiene programs together. A simple hygiene message – handwashing with soap – can help save the lives of babies,” said Katie Taylor, Deputy Child and Maternal Survival Coordinator at the U.S. Agency for International Development. “With Unilever and Lifebuoy, we are combining our expertise to achieve real change for the mothers and children in Africa – so every child in Africa can live beyond their fifth birthday.”

Senegalese politician and award-winning singer Youssou N’Dour has pledged his support to Lifebuoy’s Help A Child Reach 5 campaign to highlight the importance of hygiene in reducing child mortality, particularly in Africa. He is described as one of the world’s greatest singers and has advocated for children in Africa and abroad. “50% of the world’s under-5 deaths happens in Africa, with 1 in every 10 children born dying before their 5th birthday,” said N’Dour. “The simple act of handwashing with soap can save children’s lives and should play a key part in the post-2015 development agenda. I am calling on policymakers and governments in Africa to help make this happen by expanding handwashing education programmes.”

The Fourth Regional Conference on Sanitation and Hygiene in Africa (AfricaSan 4) is focusing on the theme: Making Sanitation for All a Reality in Africa. With the launch of the United Nations’ new Sustainable Development Goal (SDGs) in September, Lifebuoy is raising awareness of the need to track handwashing facilities and behaviours in the water and sanitation goal (SDG 6). How individual countries choose to implement the SDGs and build the targets and indicators into their own national plans will determine their success and Lifebuoy is working to ensure its message “Handwashing with soap saves lives” is heard at the highest levels in Africa.

This year’s annual day to recognize hand hygiene among health workers commemorates ten years of the Clean Care is Safer Care programme (2005-2015) of the World Health Organization (WHO).

Hand hygiene is an important element of infection prevention and control. A recent WHO/UNICEF survey of 66,000 health facilities in developing countries revealed that over a third of them lacked soap for hand washing.

Hear from experts from WHO, the London School of Hygiene and Tropical Medicine, and Johns Hopkins University on the importance of hand hygiene, the current state of practices and lessons learned from the recent West Africa Ebola Outbreak.

To join the discussion register at the site of the Global Public-Private Partnership for Handwashing.

The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited.

This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent.

Households in handwashing wards show marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures. Limited interaction is observed between handwashing and sanitation on intermediate outcomes: wards that received both handwashing and sanitation promotion are less likely to have feces visible around their latrine and more likely to have a handwashing station close to their latrine facility relative to individual treatment groups.

Final health effects on child health measured through diarrhea, anemia, stunting, and wasting are absent in the single-intervention groups. The combined-treatment group produces statistically detectable, but biologically insignificant
and inconsistent, health impacts. The results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver.

Measurement of handwashing behavior: Based on a review of numerous studies using structured observation to measure behavior, hands are washed with soap after approximately 19 percent of events that involved using the toilet or coming into contact with a child’s excreta.1

Behavior change communication: The much-awaited results from the Super-Amma campaign, a handwashing behavior change intervention based on emotional drivers such as nurture and disgust, have started to come in. These results show that this approach to handwashing promotion has lasting impact and is achieving the diffusion of handwashing as a social norm.2,3 The campaign provides further confirmation that the knowledge of handwashing benefits is linked to its practice4,5 and that women’s participatory groups6 and handwashing education in schools,7 including students’ involvement in hygiene and sanitation clubs,9 are good settings in which to build that knowledge into action. Furthermore, the mere act of checking whether households have soap seems to increase their handwashing behavior.10

Handwashing hardware: The studies reviewed provide further evidence that the availability of appropriate handwashing stations and soap in schools,7 healthcare centers,8 and in the home12,13 increases handwashing prevalence, as does having piped water and functioning sewage mechanisms.14 Research provided further evidence that soap and ash are equally effective at cleaning hands,15 and that 4g of moringa oleifera leaf powder shows promise as an effective alternative to soap or ash for handwashing.16

Benefits of handwashing: A review estimated that handwashing with soap reduces the risk of diarrhea by 40 percent.1 Excluding the studies that could theoretically have been biased (or unblinded)—researchers knowing which people were exposed to handwashing interventions and which were not— handwashing with soap was estimated to reduce the risk of developing diarrhea by 23 percent.1 Further evidence showed that having soap in the home reduces children’s episodes of diarrhea, acute respiratory infections, eye infections, helminth infections, and school absences.18,19,20,21 It was found that good handwashing interventions in school also reduce school absences (but only for girls in one study)7 and that school-based interventions reduce episodes of diarrhea in preschool-aged siblings.17

Contamination: Various studies measured hands contaminated with rhinovirus,22 E coli,5, 25and helminth eggs.23 One study inversely correlated prevalence of handwashing with the amount of influenza virus found on household surfaces.24 A final study showed that in the rural areas hands revert to baseline levels of contamination within one hour after handwashing with soap.26

Hi Eng. Mughal I very well agree with your observations. Tahunganh needs some assistance in substance. As far as I know, Dr. Barbara Senkwe PhD of USAID SUWASA has done such work in the South Sudan but I doubt if she is still available on her email address at bsenkwe@ard-suwasa.org as the project is winding up soon. We featured her article ‘An Emerging Fecal […]

Hi Virginia Thanks for your important work you are doing in Madagascar. The country was in focus in March this year as its president Mr. Hery Rajaonarimampianina became the first Chief of State in the world to sign a pledge in public to end open defecation. We presented a short mention of this in our Africa Water, Sanitation & Hygiene May-June 2015 editi […]

Hi Kris Thank you very much for your thoughts. We agree with your concerns. That's why we have given so much importance to develop the protocol so easy and cost effective which can potentially be done at the local level. However, phage therapy has been successful to treat diarrhoeal infection in human gut which is as complex as waste water system. Moreo […]

I request the users of this forum, especially the senior friends, to kindly help Hung, by responding to his survey. The survey is a bit long. He said he needs large data and a wider response. I know, PhD work requires lot of work. Like me, he is also from AIT, so, my request for his survey F H Mughal

Dear forum members, This study was done as a part of master thesis in my master degree program. Although it does have lot of initiatives to carry on this research. This business runs informally in the Bangalore city (and also might be in other cities of India), so it was a challenging task to get business details from the entrepreneurs. However, the research […]

Integration of Nutrition and WaSH programmes was the key topic discussed at the multi sectorial panel seminar hosted by Irish Aid, the IFGH and the Development Studies Association of Ireland on the 19th May.

Sustainability is without doubt one of the most burning subject matters that subsumes many of the issues that we are seeing in CLTS and wider WASH practice.On Wednesday 24th June, from 14.00-15.30 BST (convert to your time zone here), the CLTS Knowledge Hub will offer a webinar on the subject.

Over 50 female leaders from around the world recently published a declaration calling for the end of poor sanitation and hygiene in the developing world. Among those leaders are the first ladies of Madagascar and Malawi, both of whom announced the declaration in Washington, D.C.